Application of cranial bone grafts for reconstruction of maxillofacial deformities.

This retrospective study evaluated outcomes with the use of calvarial bone grafts (CBGs) in maxillofacial reconstruction as well as donor and recipient site complications. The records of 50 consecutive patients from a private practice were reviewed; there were 34 women and 16 men, with an average age of 32.4 years (range 16 to 66 years). Among the 50 patients, CBGs were placed in 63 sites: the ramus (10), nasal dorsum (14), maxilla/alveolar ridge (12), glenoid fossa/temporal bone (14), mandibular body/symphysis (3), and orbitozygomatic complex (10). The longest follow-up averaged 22.4 months (range 12 to 48 months). An outer-table CBG harvest technique was utilized. All subjects were evaluated for infection, dehiscence, loss of graft, and any other complications. Three complications occurred (5%) at the recipient sites. Two grafts became infected requiring removal, and one nasal dorsal graft was mobile but remained in position. At 50 donor sites, 2 complications (4%) occurred, resulting in dural tears in two patients that were immediately repaired with no untoward consequence. In conclusion, CBGs are an effective bone source for maxillofacial reconstruction with low donor and recipient site complications.

Simultaneous 3-dimensional Le Fort I/distraction osteogenesis technique: positional changes.

PURPOSE: This preliminary study assesses the positional changes of the maxilla after simultaneous 3-dimensional Le Fort I osteotomy and distraction osteogenesis (3D-LFI/DO). PATIENTS AND METHODS: The records of 18 patients, 17.7 years of age (range, 12-38 years) at the time of surgery, manifesting transverse maxillary deficiencies and variable sagittal/vertical deformities were evaluated presurgically and 3 years postsurgery (range, 1 to 10 years). All patients underwent midsagittal 2-piece Le Fort I osteotomies. The planned sagittal and vertical positional changes were immediately performed by the Le Fort I surgery. After a latency period of 5 to 7 days, maxillary expansion was slowly achieved by distraction osteogenesis using a Hyrax appliance activated 1-mm/day. Once the planned transverse expansion had been attained, the Hyrax device served as a retention appliance for 8 to 12 weeks, after which the distraction gap was orthodontically closed. The morphological changes were assessed by comparing standardized preoperative and postsurgical models, posterior-anterior radiographs, and lateral cephalograms. RESULTS: Class I canine and molar relationships, along with satisfactory sagittal and vertical skeletal relationships, were observed at follow-up. The maxilla was advanced (1.5-1.8 mm) and positioned either superiorly or inferiorly (1.2-2.9 mm), depending on the original deformity. The arch perimeter increased 5.4 mm and the arch width increased between 4.2 and 6.6 mm. The maxillary expansion was nonparallel, greater anteriorly and inferiorly. CONCLUSIONS: The 3D-LFI/DO can be used to simultaneously and selectively widen, lengthen and vertically reposition the maxilla, producing acceptable post-treatment skeletal and dental relationships, without healing problems observed clinically.

Outcomes of treatment with custom-made temporomandibular joint total joint prostheses and maxillomandibular counter-clockwise rotation.

The first 25 consecutive patients with high occlusal plane angulation, dysfunction, and pain who were treated with temporomandibular joint (TMJ) total joint prostheses and simultaneous maxillomandibular counterclockwise rotation were evaluated before surgery (T1), immediately after surgery (T2), and at the longest follow-up (T3) for surgical movements and long-term stability. Subjective ratings were used for patients' facial pain/headache, TMJ pain, jaw function, diet, and disability, and objective functional changes were determined by measuring maximum incisal opening and lateral excursive movements. Results showed that the areas of greatest surgical change included an average decrease in the occlusal plane of 13.3 degrees with advancement at point B of 13.4 mm and at the genial tubercles of 16.3 mm. At longest follow-up, relapse was 0.7 degrees, 0.8 mm, and 1.2 mm, respectively, with no statistically significant changes. Significant subjective pain and dysfunction improvements were observed (P ≤ 0.001). Maximum incisal opening increased, but lateral excursion decreased. Those who had two or more previous TMJ surgeries showed greater levels of dysfunction at T1 and T3 than those who had one or no previous surgeries, but otherwise patients presented similar amounts of absolute changes. In conclusion, end-stage TMJ patients can achieve significant improvement in their pain, dysfunction, dentofacial deformity, and airway problems in one operation with TMJ reconstruction and mandibular advancement using TMJ custom-made total joint prostheses and simultaneous maxillary osteotomies for maxillomandibular counter-clockwise rotation.